Braces for correcting hip dislocation



p 1966 G. F. HEWSON, JR

BRACES FOR CORRECTING HIP DISLOCATION 2 Sheets-Sheet 1 Filed Sept. 23, 1963 INVENTOR gear Z9 I. He wsorz, Jr.

Y m m J ATTORNE P 27, 1966 a. F. HEWSON, JR 3,274,997

BRACES FOR CORRECTING HIP DISLOGATION Filed Sept. 25, 1963 2 Sheets-Sheet 2 INVENTOR geozye E HewsomJr.

United States Patent 3,274,997 BRACES FOR CORRECTING HIP DISLOCATION George F. Hewson, Jr., Palisade, NJ., assignor to St. Lukes Hospital Center, New York, N.Y., a corporation of New York Filed Sept. 23, 1963, Ser. No. 310,787

1 Claim. (Cl. 128-78) The present invention relates to a hip abduction brace of improved type adapted more particularly for the treatment and correction of congenital dislocation of the hip.

The correction of hip dislocations existing before or occurring at the time of birth has long presented baflling problems to the medical profession. Among various known expedients heretofore employed for this purpose in hospitals, for example, are the Frejka pillow, the Jordan abduction brace, the Freiburg brace, traction-abduction braces, the Ilfeld brace, the plaster spica or bandage and others. Although these devices have been used effectively in treating many congenital hip dislocations, they have failed in more difncult cases to maintain the femoral head in the acetabulum after reduction, as where re-dislocation occursduring post reduction treatment, for example.

In general, the treatment for congenital hip dislocation commonly involves manual adjustment of the femur to bring its inner end or head into proper register with the acetabulum While the patients hips are at 90 flexion and 90 abduction. Thereafter, the problem is to maintain this relationship with suificient accuracy and long enoughso that a normal-1y effective hip socket may be developed. In some cases manual reduction cannot be effected; and mechanically aided reduction'involves prolonged procedures and the use of uncomfortable appliances or expedients.

Regardless of the extent of their functional effectiveness, some of the known devices in the art also present difficult problems of patient care, maintenance of hygiene and adequate accessibility of the involved parts for obtaining periodic X-rays.

In this connection, previously attained abduction is commonly lost when the brace is removed for any reason, as for toilet care, X-ray examination, etc. These unfavorable conditions have not been satisfactorily resolved.

An object of the present invention, accordingly, has been to provide a hip abduction brace of simple and relatively inexpensive construction which, when applied to a patient having a congenital hip dislocation, will facilitate or effect socketing of the femoral head or reduction of the dislocation Where, asin some cases, manual reduction is not feasible and will effectively immobilize the defective joint in reduce condition and so prevent any redislocation during further corrective treatment.

An object has been also to provide a hip abduction brace adapted to maintain permanent closed reduction of both hips simultaneously where needed, thus allowing the acetabulum to develop most effectively toward normal condition in one or both hips.

A further object is to provide a brace whereby any desired or necessary degree of pressure may be applied to an area of the upper thigh in a direction to effect corrective movement of the femur and to control and thus effectively retain its inner end or femoral head in proper relation to the acetabulum, in spite of allactivity of the child patient and in spite of handling incident to nursing care.

A further purpose has been to provide an appliance for the indicated use which may remain in operative position on the patient over extended periods of time, as months where needed, with minimum discomfort to the wearer; which permits complete toilet care and handling by other than a physician; and which, while in place permits the taking of all necessary X-rays.

In general, a conventional hip abduction brace, as of the Jordan type, illustrated in Orthopedic Appliances pp. 242244 London, Oxford Univ. Press, 1939, includes a rigid frame comprising posterior pelvic and lateral thigh bars, a. frame retaining belt adapted to be fastened around the patients waist, and a knee strap attached to an outer end of each thigh bar. Appropriate pads are interposed in use between the frame parts and the patient. A brace according to the present invention and constituting an improvement over said Jordan device, for example, includes a rigid frame having pelvic and thigh bars as above described and, in addition, a pressure plate and pad mounted for adjustment on each thigh bar at its under side near its inner end.

The pressure plate is advantageously swivelled at the lower end of a stem which is mounted on the thigh bar and adjustable in use in a direction to move said plate by closely controlled increments toward the upper endportion of the thigh and thus to apply corrective pressure to the upper or inner end portion of the femur. In a preferred embodiment, the pelvic bar and the thigh'bars are made adjustable to permit variation of the frame dimensions to accommodate patients of different sizes, or for adjustment to growth of the same patient where the period of correction is of extended duration, and to facilitate proper positioning of the pressure plate over the head of the femur. v

Other objects and distinctive features of the present invention not above referred to will appear from the following specification and claims and from the accompanying drawings wherein is shown a preferred embodiment thereof incorporated in a hip abduction brace as described in said specification. The showing so made is not intended to be either exhaustive or as limiting the scope of the subject invention. The present purpose is to illustrate the invention so that others skilled in the art may so fully understand it, its principles and applications, that they may embody it and adapt it in any of various forms appropriate to the attainment of any particular or appropriate purpose in use.

In the drawings: a

FIG. 1 is a front view in perspective of a brace according to the invention with parts broken away and with the front retaining strap and one of the leg straps in open condition;

FIG. 2 is a fragmentary view on enlarged scale with parts broken away and with parts shown in longitudinal vertical section of a portion of said hip abduction brace as it appears when applied to a patient's body, indicated in dotted lines, to maintain the femur in corrected condition (shown full line) after reduction from dislocated condition (shown dotted);

FIG. 3, a diagrammatic view illustrating a typical hip dislocation prior to reduction to corrected position (seen in FIG. 2 full line) of the upper femur and femoral head (shown dotted) in relation to the acetabulum and with the brace in position to effect said reduction;

3 FIG. 4, a transverse vertical section showing details of construction of the pressure plate; and

FIG. 5 is a top plan view of the pressure plate seen in FIGS. 1,2 and 3 from the line 55 of said FIGURE 4.

Referring to FIG. 1 of the drawings, a brace embody-v ing the invention as there shown includes a rigid frame of suitable material providing a torso conforming band as pelvic bar and a thigh bar 11 including an upright portion secured at its upper end to an end portion of said pelvic bar 10 and an arm portion extending substantially perpendicularly from the lower end of saidupright portion to an extent approximately the length of the, intended patients thigh, or the distance from knee to hip. The length of said arm portion may be varied by providing at its outer end a longitudinally adjustable extension piece 12 conveniently secured in different longitudinal positions thereon by suitable means, as screws 13. Also the effective length of pelvic bar 10 may be varied by making it in two pieces, for example, with their inner ends overlapping in different degrees and secured together in a desired posi tion as by screws 14 engaging holes 15. This arrangement provides not only 'for'use of the brace on patients of different torso,dimensions oron thesame patient at different stages of growth but also permits more accurate adjustment of the pressure plate, i.e., either outwardly from or inwardly toward the hip joint. The upright portion of each thigh bar 11 is secured by suitable means, as

rivets, to a front end portion of the torso conforming bar 10. p i

Provision is made for securing the rigid frame of the brace to the body of a patient by suitable attaching devices. conventional splinting position with hips at 90 flexion and 90 abduction, the arm portion of thigh bar 11 isv positioned above and oppositethe upper surface of the patients thigh and at an angle thereto depending on the angle of dislocation of the femur and the extent and direc-.'

tion of its intended reduction. Thus, bar 11 has-secured at the outer end of its arm position, as by'rivets for example, a band means 16 .(FIG. 2) which encircles the patients lower thigh above or inwardly from the knee joint; and a pad l'lof suitable shape and material, as foamv rubber, is'inserted between the band means 16 and the thigh. The frame including the inner upturned end of thigh bar 11 and'the posterior pelvic bar 10 is fastened to r the patients torso by a belt 18 secured in front, as by a .strap 18' and 18", in position to cover said pelvic bar 10 and the upperend of theupright portion of thigh bar 11 and toretain a suitable 'pad 19 interposed between the frame and the patients torso.

The brace fastening devicesabove referred to are con ventional and provide in effect secure attachment of the brace to the patient. However,a conventional brace so In a typical case, where the patient is brought into attached is not capable ofrus'e in eflecting reductions of hip dislocations, and under some conditions, is inadequate to maintain a reduction previously made between thefe mur head and the acetabulum, such maintained relation being necessary to effect permanent-correction of the hip dislocation. Accordingly, to provide a brace according to my invention and which in use accomplishes the desired results a pressure plate 20 'is. mounted at'the under side of and adjacent to an inner or pelvic end portion of bar 11.

To exert controlled pressure on plate 20, the latter is conveniently connected, as by a swivel joint, at the lower end of the stem ofa set screw 21 extending through a threaded hole in barll. 11 is attached to the patient, as above described, and the desired pressure is applied to and maintained on an inner end portion of the femur in reduced condition through plate 20 and pad 22 by manipulating said'screw 21, a three point stabilization is effected which can maintain optimum immobilization of the hip joint over extended periods. Y 1 f The inner end edge of plate 20 is advantageously flared Thus, when the frame including said bar upwardly at 23, as seen in FIG. 2 for example, to conform to thigh contours as defined by soft tissue overlying the hip joint and lateral wall of the ilium and to gently control motion of the. confined parts. Said edge isalso slightly; indented or reentrant in contour, as at 24,'FIG. 5. As seen in FIG. 4, plate 20 is of arched or bowed cross sectionalcontour and all its peripheral edges are preferably rounded. These details of the form of pressure plate 20 and its swivel mounting not only contribute to the comfort of the patient wearing the brace but also tend to transmit to'the femur and retain the applied corrective pressure inthe proper direction and in the most effective fect reduction the brace is attached as shownin FIG. 1

and pressure plate 20 is adjusted downwardly by set. screw 21 (see arrow) as'above described. Thus, the head end of femur A is, ineifect, directed downwardly toward-its reduced position opposite the acetabulum C. Concurrently, the knee strap 16 at the knee joint is adjusted in a 7 direction (see arrow) to direct the outer end of femur A- upwardly, or, when adjusted to a desired position, to func-.

tion as a fulcrum to limitdownward deflection ofthe outer end of the femur when downward :pressure is: applied to the inner end thereof. The net effect is to adjust femur A gradually from its dotted line position toward its reduced corrected position (full-line) as seen in FIG.;2 .Z

Where plate 20 and/or band means716 are. adjusted periodically by small degrees whichmay convenientlybe indicated by spaced (one centimeter, for example);'and

numbered markings 25 on band means,16,the progress of the reduction can be accurately checked by X-ray procedures withoutdisturbing or removing the braceQ And when thereduction has been attained, as in FIG. 2 ,(full line), the brace operates to maintain'the femurnin corrected or reduced position. Thus, plate 20 cooperating with knee band means 16 prevents displacement in a vertlcal planewhile the depending edgeportionsof plate'20 defining its transversely. bowed or arched contour tend to thereof in a horizontal direction, as seen in FIG; 2..

It appears from the foregoing that a brace according to restrainathe femur against displacement of the. head B {my invention serves the novel and highly desirably func -tlOI1 m use of completely'stabilizing or maintaining a reduction regardlessof the method .by which 'it has been achieved. In some cases, where-reduction hadgbeen'effected but wasfunstable, I was able, by the use-,of a-brace embodying my invention, to effectively maintain there-" duction withoutredislocation in spite of the activity ofthe patient and handling by physicians and nurses,or byth'e m ther at home. v

I In many cases of congemtal hip dislocation, reduction can be accomplished by known manual procedures and, in other more res1stant cases, byvariou'smechanical or combined mechanical and manual: operations. However, the above described reducing procedure eflfected by use of a brace according to my invention is also particularly effective in hip dislocations which resist conventional manual reduction and which would commonly call for more complex and long duration operations. involving traction,

casts; etc." Thus, by/the use of my brace'in a casezresistant to manual reduction methods, I have accomplished. a novel "and unexpected reduction in gradual degrees within a period of five days with a minimum of discomfort to the patient and complete accessibility by physician and nurse for all usual purposes.

What is claimed is: In a brace for treating congenital hip dislocation,-'th

combination of a rigid frame including a pelvic bar of longitudinally curved contour for conformably engaging a peripheral portion of a patients torso and two laterally arranged thigh bars each secured to an end portion of said pelvic bar, each thigh bar including an upright portion secured at its upper end to a portion of said pelvic bar and an arm portion extending substantially perpendicular from said upright portion, said arm portions extending outwardly from said pelvic bar in opposite directions and substantially colinear, each of said arm portions having band means at its outer end adapted to be fastened around and encircle a patients lower thigh opposite the outer end of the femur, each thigh bar having a pressure plate mounted on the arm portion adjacent the upright portion, said pressure plate being concave and having a flared inner edge portion to conform to the thigh and body junction, said pressure plate mounting means including adjustable means to exert corrective pressure on the upper thigh in a direction toward the femur head while the outer end of the femur is held against displacement by said band 6 means encircling the patients lower thigh above the knee joint.

References Cited by the Examiner UNITED STATES PATENTS 2,091,643 8/1937 Longfellow l2884 2,187,323 1/1940 Kelton et a1. 128-87 2,584,203 2/1952 Hart 12884 OTHER REFERENCES RICHARD A. GAUDET, Primary Examiner.

J. W. HINEY, Assistant Examiner. 

